MEXICAN HEALTH INSURANCE – WHAT YOU NEED TO KNOW.
The term Mexican health insurance refers to private health insurance companies registered in Mexico that operate under the National Mexican Health Insurance Commission. Some of the Mexican health insurance companies include AXA , Allianz, GNP, & Mapfre.
What´s important for Expats to know is that Mexican health insurers ONLY provide service & documentation in SPANISH. If you are not fluent in Spanish, then it represents a risk to depend on your insurance agent / broker to translate & interpret all of the insurance policy guidelines, requirements, & claims processes for you.
Another consideration are deductibles. Mexican health companies offer plans with separate deductibles for all medical diagnoses. With separate deductibles, there are no caps on the total deductible amounts you could pay per year. Also, Mexican insurers will charge an additional deductible even if a new illness is related to a prior diagnosis. For example, heart attack & heart valve repair would be considered two separate diagnosis even though they are both related to the heart.
In addition, Mexican health insurance plans have co-insurance, which is a percentage of medical expenses the insured has to pay in addition to the deductible. Co-insurance percentages normally have co-insurance maximum amounts per event.
Here is an example with 2019 real surgery costs for a robotic prostatectomy in Mexico:
A policyholder has a health plan that includes a $20,000 Mx. peso per illness deductible and 15% co-insurance responsibility up to $35,000 Mx. pesos per event.
Prostatectomy hospitalization costs billed to insurance company: $340,000 Mx Pesos
Deductible amount: $20,000 Mx Pesos
Co-insurance amount: $35,000 Mx Pesos (max amount per event)
Total amount paid by insured: $55,000 Mx Pesos = $2,894 USD (using exchange rate of $19 pesos per USD).
Here are the amounts the same individual would have paid if he had an Expat health plan ($0 Co-insurance & one annual deductible amount per policy year).
Prostatectomy hospitalization costs billed to insurance company: $340,000 Mx Pesos
Deductible amount: $1,000 USD = $19,000 Mx. Pesos
Co-insurance amount: $0
Total amount paid by insured: $1,000 USD = $19,000 Mex. Pesos.
If the Expat plan insured person were to need any other medical service in the policy year, since his annual deductible obligation has already been met, he could expect the insurance company to reimburse him for all covered medical expenses during the remainder of his policy year.
If the Mexican health plan insured were to need any other – non-related medical services, he could expect to have to pay an additional deductible.
The only exception to this case is if the hospitalization event in question is related to an accident. If this is the case, the Mexican health plan insured could expect their deductible to be waived. Such is the case for many of the Expat health plans as well. Deductibles are waived for accidents resulting in hospitalization.
When purchasing health insurance in Mexico, it is important to consider your total out-of-pocket costs (total annual premium + deductible(s) + co-insurance amounts). When you purchase a Mexican health insurance, calculating this amount is difficult, because there is no way to estimate how many illnesses you may be diagnosed with in a given year (deductible & co-insurance totals). Expat health plans, on the other hand, mitigate this risk for customers by providing annual deductible maximums and $0 co-insurance.
For more information on Mexican health insurance options, please contact melanie@mexicoinsuranceadvisors.com or call Mx Cell 415-108-0810 / USA 971-327-7187 – We are a full brokerage firm representing Mexican, International & Expat health plans in Mexico.
